Nasotracheal intubation in the presence of frontobasal skull fracture.
OBJECTIVE
To present a case of maxillofacial trauma and basal skull fracture (BSF) in whom nasotracheal intubation (NTI) was successfully used, without complication, to facilitate surgical fixation. To present alternative methods of airway management in this situation and to review the evidence supporting the notion that NTI is contraindicated in the presence of basal skull fracture.


METHODS
A 17-yr-old man was referred for surgical fixation of bilateral mandibular fractures. Cranial computed tomography revealed intracranial air and blood in all four sinuses and distortion of the nasal passage on the right. There was no cerebral injury and the left nasal passage appeared patent. In order to facilitate intraoperative intermaxillary fixation fibreoptic NTI was undertaken in preference to tracheostomy. The patient made an uneventful recovery without evidence of meningitis or direct cerebral injury.


CONCLUSIONS
In selected patients NTI may be performed in the presence of BSF. Available evidence suggests that BSF-should not be regarded as an absolute contraindication to NTI.
Arrowsmith
J E
JE
Department of Anaesthesia, St George's Healthcare NHS Trust, London, UK. arrow002@mc.duke.edu
Robertshaw
H J
HJ
Boyd
J D
JD
D000293:Adolescent; D001930:Brain Injuries / Q000517:prevention & control; D002559:Cerebrospinal Fluid Rhinorrhea / Q000517:prevention & control; D000075202:Contraindications; D005336:Fiber Optic Technology; D005592:Fracture Fixation; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods; D007828:Laryngoscopy; D008297:Male; D008337:Mandibular Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D008581:Meningitis / Q000517:prevention & control; D009296:Nasal Cavity / Q000000981:diagnostic imaging / Q000293:injuries; D010256:Paranasal Sinuses / Q000000981:diagnostic imaging / Q000293:injuries; D012119:Respiration; D019291:Skull Base / Q000000981:diagnostic imaging / Q000293:injuries*; D012887:Skull Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014139:Tracheostomy; D015051:Zygomatic Fractures / Q000000981:diagnostic imaging / Q000601:surgery*